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Background The positive effects of wearing a mouthguard on shock absorption have been indicated in various papers. The ability of a mouthguard to protect against indirect injury, however, is not clear, and the thickness that a mouthguard would require to provide such protection remains to be determined. The primary aim of this study was to clarify the shock absorption potential of a mouthguard against forced, traumatic occlusion. The secondary objective was to compare the shock absorption ability of different thicknesses of mouthguard against this type of trauma. Materials and methods An artificial skull (ZA20; 3B Scientific International, Co. Ltd, Niigata, Japan) with two-axis strain gages applied to the right buccal aspect of the mandible and the mandibular and maxillary teeth was used to measure shock absorption ability. Three different thicknesses of EVA mouthguard (1, 2, and 3 mm at the first molar) were tested. Results and conclusions Within the limitations of this laboratory study, the following results were obtained: the results showed that increasing the thickness of the mouthguard improved its shock absorption ability.

The positive effects of wearing a mouthguard have been indicated in various epidemiological surveys and experiments, and their usage appears to be increasing in many sports. However, many preventable sports-related dental injuries still occur even with the use of a conventional mouthguard. We have developed a mouthguard (the Hard & Space mouthguard) with sufficient injury prevention ability (more than 95% shock absorption ability against impact with a steel ball carrying 15.2 kg m(2) S(-2) potential energy) and ease of clinical application. This mouthguard consists of an outer and an inner EVA layer and a middle layer of acrylic resin (hard insert), with a space to prevent contact between the inner surface of the mouthguard and the buccal surfaces of the maxillary front teeth or teeth already weakened through prior damage or treatment. The purpose of this article is to describe the method by which the Hard & Space mouthguard may easily be fabricated. We believe that this new type of mouthguard has the potential to reduce sports-related dental injuries.

The manufacture of laminated-type mouthguards requires skill in fusing sheets of mouthguard materials together. Adequate adhesive strength is required to use mouthguards in a stable condition for a long time. Therefore, in this study, the exfoliation test was applied and some treating techniques and conditions that improve the adhesive strength on a laminated surface were examined. Samples were laminated with two pieces of mouthguard material (3 mm thickness) having an adhesive area of 5 x 5 mm2, and whose other end was the holding part. The experimental factors used were as follows: heating time, use of solvent, elimination and direct heating of the laminate surface, colour of materials and water sorption. The result was measured at the time of breakage of the maximum load (N) and the form of destruction was examined. At 165 s of heating time, material failure was shown at under a load exceeding 5.0 N when compared to an untreated condition. Material failure was measured when a solvent was used and during the elimination of the laminated surface at a heating time of 150 s, which is 15 s lesser than in an untreated condition. Material failure was also measured by direct heating on the bonding surface of a second sheet of material at a heating time of 135 s, which is 30 s lesser than in an untreated condition. The differences in colour of the materials influence adhesion. Clear and light coloured materials showed higher adhesion ability. One-way analysis of variance confirmed a statistically significant difference in heating time differences, usage of solvent, elimination, direct heating on bonding surface and colour (P < 0.05). The decrease of adhesive strength by water sorption at 23 degrees and 37 degrees C was not observed significantly. Maximal laminated bond strength can be obtained by minimal heating time and proper treatment with the use of solvent, elimination and direct heating on bonding surface. The differences in the colour of the materials influenced adhesion. Clear and light coloured materials showed higher adhesive ability. Water sorption did not affect the adhesive strength. Therefore, if laminated-type mouthguards were manufactured properly, it can be used for a longer time and in a good condition.

Some sports' accidents are responsible for inflicting traumatic brain injuries and mandibular bone fractures when impacts occur to the chin. It is often thought that mouth guards can prevent many of these injuries. However, such assertions may be insufficient without adequate research. It is therefore necessary to establish a systematic method of investigation to solve this problem. In the present laboratory study, tests were performed using pendulum impact equipment and an artificial skull model connected to strain gages and accelerometers to simulate and measure the surface distortions related to bone deformation or fractures and the acceleration of the head related to concussions. As impacts, direct blows to the mandibular undersurface were applied. As a result, wearing a mouth guard decreased (P < 0.01) the distortion to the mandibular bone and the acceleration of the head significantly compared with not wearing a mouth guard (54.7%: to the mandible -- measured at a total of three different points, 18.5%: to the head measured at a total of three different points). Within the limits of this study, the following conclusions were drawn: The present measuring system in this study was able to evaluate the distortion to the mandibular and the acceleration of the head from the direct blow to the mandibular undersurface. Mouth guards can reduce distortion to the mandibular and the acceleration of the head from the same blow. So mouth guards might have the possibility to prevent mandibular bone fractures and concussions. However, further well-designed and exhaustive studies are vital to show that mouth guards reduce the incidence of concussions and mandibular bone fractures.

The safety benefits of mouthguards have been demonstrated in many studies, with many authors and sports dentists strongly recommending the wearing of mouthguards. However, wearing a mouthguard with incorrect occlusion might cause a variety of problems. It comes as no surprise that a traumatic blow to the chin, while wearing an insufficient mouthguard lacking anterior contact, can result in severe distortions to the mandibular bone, and bone fractures. The aim of this study was to clarify how ineffective insufficient occlusal supporting mouthguards are and how dangerous they can be to use. Consequently, in this study, occlusal supportive areas were varied and accelerations of head and distortions of the mandible were measured using an artificial skull model and a pendulum impact device. As a result, the distortions of the mandible tended to increase as the supported area decreased. On the contrary, accelerations of the head decreased as the occlusion part decreased. Thus, a lot of impact energy was consumed in the distortion of the mandible; accordingly, it seemed that only a little destructive energy was transferred to the head. From this study, it would seem that wearing a mouthguard, which is insufficient in the occlusion, has the potential of causing a bone fracture of the mandible. Consequently, mouthguards should have proper occlusion.

Most impact force and impact energy absorption tests for mouthguards have used a steel ball in a drop-ball or the pendulum device. However, in reality most sports-related trauma is caused by objects other than the steel ball, e.g. various sized balls, hockey puck, or bat or stick. Also, the elasticity, the velocity and the mass of the object could change the degree and the extent of injuries. In this study, we attempted to measure the impact force from actual sports equipment in order to clarify the exact mechanism of dental-related sports injuries and the protective effects of mouthguards. The present study was conducted using the pendulum impact device and load cell. Impact objects were removable. Seven mobile impact objects were selected for testing: a steel ball, baseball, softball, field hockey ball, ice hockey puck, cricket ball, and wooden baseball bat. The mouthguard material used in this study was a 3-mm-thick Drufosoft (Dreve-Dentamid GmbH, Unna, Germany), and test samples were made of the one-layer type. The peak transmitted forces without mouthguard ranged from the smallest (ice hockey stick, 46.9 kgf) to the biggest (steel ball, 481.6 kgf). The peak transmitted forces were smaller when the mouthguard was attached than without it for all impact materials but the effect was significantly influenced by the object type. The steel ball showed the biggest (62.1%) absorption ability while the wooden bat showed the second biggest (38.3%). The other balls or the puck showed from 0.6 to 6.0% absorbency. These results show that it is important to test the effectiveness of mouthguards on specific types of sports equipment. In future, we may select different materials and mouthguard designs suitable for specific sports.

The aim of this study was to clarify and quantify factors influencing thinning during a thermoforming using a special simulation model that has three different flat surfaces such as 0 degree, 45 degree and 90 degree against a pressurizing force. Air pressure type samples were made by EVA and acrylic resin blank. Vacuum type samples were also made by EVA. Thickness gauge was employed to measure the thickness. As results, pressure forming showed significantly larger thinning at 45 and 90 degree surfaces and smaller thinning at 0 degree surface, 36% in thinning rate by vacuum forming and 66% by the pressure forming at 90 degree surface, and 17% and 20% at 45 degree surface, and 11% and 2% at 0 degree surfaces. Thinning was increased with the increase in distance from the centre in 0 degree surface and increased with the decrease in height in the vertical surface significantly. The air pressure, the material thickness in EVA (Drufosoft) and difference in material colour did not affect thinning rate. An acrylic resin material showed approximately 10% smaller thinning than EVA (Drufosoft). To retain enough thickness of 3 mm on 90 degree surface corresponding to an incisal labial aspect for pressure laminate type, over 55% reduction is taken into consideration and at least two 3-mm-thickness materials should be laminated. 0 degree surface showed at most 2 % reduction in pressure lamination; post thermoforming occlusal thickness became almost 6 mm with a usual 3 mm plus 3 mm lamination. Therefore, careful occlusal adjustment in an actual mouthguard fabrication to achieve an appropriate 2 mm thickness on this surface should be requested.

A full-balanced occlusion is essential for mouthguards. It has been reported that a balanced occlusion for upper and lower anterior teeth is essential for prevention of injuries occurring to the maxillary anterior teeth and alveolar bone caused by horizontal direct impact. The support of the mandibular teeth through the mouthguard is critical to prevent maxillary front tooth injury from a direct impact force. However, some vacuum mouthguard designs may not achieve a full-balanced occlusion. For example, when a player has a malocclusion, an elongated molar or premolar tooth, an open bite, a large over jet or a maxillary protrusion. An improved vacuum fabrication method is necessary to obtain full balanced occlusion in these cases as opposed to conventional vacuum type single-layer mouthguard technique. Language: en

BACKGROUND: Concussions are common among athletes, with the potential to cause memory-related, physical, cognitive, emotional, and behavioral damage. A concussion is an acceleration/deceleration injury resulting from direct and indirect biomechanical forces transmitted to the cerebral tissues. From a sports dentistry viewpoint, increased mastication muscle activity or clenching due to the presence of a mouthguard may enhance cervical muscle activity, thereby reducing damage following impact. This relationship has not been previously investigated in the context of rugby. The purpose of this study was to investigate the effect of voluntary clenching on indirect head acceleration during attack- and defense-related drills. MATERIALS AND METHODS: A total of 12 high school rugby players participated in the study. Linear acceleration of the head was measured using an accelerometer that took measurements in three axes. Masseter and sternocleidomastoid muscle activities were measured using wireless electromyography. These data were synchronized using digital video imaging software for analysis. The study protocol was approved by the Tokyo Dental College Ethics Committee. RESULTS AND CONCLUSIONS: Within the limitations of this study, the following results were obtained: the activities performed during rugby practice involved relatively small indirect head acceleration and masseter and sternocleidomastoid muscle activities. After the young male rugby players were instructed to clench their masseter muscles, a marked decrease in head acceleration was observed. Language: en

A rugby player who had frequently experienced soft tissue injuries while playing rugby and wearing a conventional custom-made mouthguard came to the hospital clinic. The patient had suffered traumatic soft tissue injuries such as lip lacerations and bite trauma. Severe crowding due to ectopic maxillary and mandibular canines was observed. In response to the patient's request for better protection, a set of maxillary and mandibular mouthguards was designed: one covering the entire maxillary dentition and the other the mandibular front teeth only. The mouthguards were to be worn simultaneously. In this paper, we describe how these mouthguards were fabricated and discuss the results. The patient has experienced no injury to the stomatognathic system, including the lips, for five seasons since he began wearing this set of mouthguards. This new pairing of mouthguards appears to offer sufficient protection against injury, despite severe malalignment. We believe that this new type of paired maxillary and mandibular mouthguards has the potential to reduce sports-related dental injuries.

The purpose of this study was to clarify the influence anterior occlusion, of mouthguards, has on protecting against a direct collision to the maxillary anterior teeth. In other words, the support mandibular dentition has when wearing a mouthguard. Two types of mouthguards were used for this study, one with an appropriate anterior occlusion or a mouthguard with positive anterior occlusion (MGAO+) and another which was a single-layer mouthguard lacking the same occlusion or a mouthguard with negative anterior occlusion (MGAO-) but with the same thickness on the buccal side. The instruments used for testing were a pendulum-type impact device with two interchangeable impact objects (a steel ball and a baseball), with a plastic jaw model having artificial teeth. Four testing conditions were observed: one with the jaw open without a mouthguard (Open NoMG), the second with the jaw clenching (loaded with 30 kg weight) without a mouthguard (Clench. NoMG), the third with the jaw clenching with MGAO- (Clench. MGAO-) and the last with the jaw clenching with MGAO+ (Clench. MGAO+). The results are as follows: both types of mouthguards showed the effects in reducing the distortion of the teeth. However, the effect was significantly obvious (steel ball = about 57% shock absorption ability, baseball = about 26%) in the mouthguard with anterior occlusion or support by lower dentition through mouthguard (Clench. MGAO+) than Clench. MGAO-. Thus, the influence of anterior occlusion of mouthguards or the support of mandibular dentition through wearing a mouthguard (MGAO+) is indispensable in reducing the impact force and tooth distortion. The results of this research should further contribute to the establishment of guidelines for safer mouthguards.

Purpose: To date, the minimum thickness required for a mouthguard has been assumed to be around 2 mm to 4 mm. However, this figure is based mostly on experience and is yet to be standardized. The purpose of this study is to determine the minimum thickness required to obtain sufficient energy absorption.Methods: The thicknesses of the tested ethylene vinyl acetate) samples were 1, 2, 3, 4, 5, and 6 mm. The pendulum-type testing equipment used in the present study was also used in a series of earlier studies. Three types of sensors (strain gauge, accelerator, and load cell) and two different impact objects (a steel ball and baseball) were used.Results: The results showed that all the abovementioned mouthguard thicknesses reduced shocks for all the three types of sensors and both types of impact objects; little difference was observed between sensors and clear results were obtained for the steel ball. An improvement in the energy absorption was observed with an initial increase in the thickness. However, a further increase in the thickness from 4 mm to 5 mm and 6 mm tended to yield a smaller improvement in energy absorption.Conclusion: Within the limitations of this study, from the viewp int of energy absorption ability, the minimum thickness required for a mouthguard is 4 mm, which is generally too large from the viewpoint of player comfort. This finding indicates the necessity of improving the impact absorption ability of mouthguards by considering new designs and developing new materials.

Mouthguards are expected to reduce sports-related orofacial injuries. Numerous studies have been conduced to improve the shock absorption ability of mouthguards using air cells, sorbothane, metal wire, or hard material insertion. Most of these were shown to be effective; however, the result of each study has not been applied to clinical use. The aim of this study was to develop mouthguards that have sufficient prevention ability and ease of clinical application with focus on a hard insertion and space. Ethylene vinyl acetate (EVA) mouthguard blank used was Drufosoft and the acrylic resin was Biolon (Dreve-Dentamid GMBH, Unna, Germany). Three types of mouthguard samples tested were constructed by means of a Dreve Drufomat (Type SO, Dreve-Dentamid) air pressure machine: the first was a conventional laminated type of EVA mouthguard material; the second was a three layer type with acrylic resin inner layer (hard-insertion); the third was the same as the second but with space that does not come into contact with tooth surfaces (hard + space). As a control, without any mouthguard condition (NOMG) was measured. A pendulum type impact testing machine with interchangeable impact object (steel ball and baseball) and dental study model (D17FE-NC.7PS, Nissin, Tokyo, Japan) with the strain gages (KFG-1-120-D171-11N30C2: Kyowa, Tokyo, Japan) applied to teeth and the accelerometer to the dentition (AS-A YG-2768 100G, Kyowa) were used to measure transmitted forces. Statistical analysis (anova, P < 0.01) showed significant differences among four conditions of NOMG and three different mouthguards in both objects and sensor. About acceleration: in a steel ball which was a harder impact object, shock absorption ability of about 40% was shown with conventional EVA and hard-insertion and about 50% with hard + space. In a baseball that was softer compared with steel ball, a decrease rate is smaller, reduction (EVA = approximately 4%, hard-insertion = approximately 12%, hard + space = approximately 25%) was admitted in the similar order. A significant difference was found with all the combinations except for between EVA and hard-insertion with steel ball (Tukey test). About distortion: both buccal and lingual, distortions had become small in order of EVA, hard-insertion, and hard + space, too. The decrease rate is larger than acceleration, EVA = approximately 47%, hard-insertion = 80% or more, and hard +space = approximately 98%, in steel ball. EVA = approximately 30%, hard-insertion = approximately 75%, and hard + space = approximately 98% in baseball. And a significant difference was found with all the combinations (Tukey test). Especially, hard + space has decreased the distortion of teeth up to several percentages. Acceleration of the maxilla and distortions of the tooth became significantly smaller when wearing any type of mouthguard, in both impact objects. But the effect of mouthguard was clearer in the distortion of the tooth and with steel ball. Considering the differences of mouthguards, the hard-insertion and the hard + space had significantly greater buffer capacity than conventional EVA. Furthermore, hard + space shows quite high shock absorption ability in the tooth distortion. Namely, hard + space has decreased the distortion of teeth up to several percentages in both impact objects.

PURPOSE Most of the mouthguards on the market are inferior in fit and occlusion related to feeling and injury prevention capacity. Therefore, it is necessary to use appropriate custom-made mouth-guards. This research aimed to obtain data for the selection, improvement, and spread of mouthguards in the future. A questionnaire survey of dentists who had made four kinds of mouthguard was conducted in a mouthguard seminar. METHODS The questionnaire survey concerning "feeling", "difficulty of production", and "selection when considering use and spread" was done for four kinds of mouthguard. The evaluations were made using a ten-point method with the Kruskal-Wallis test and Mann-Whitney U-test. RESULTS Concerning the feeling: The laminated mouthguard was evaluated the highest, followed in order by improvement type, vacuum, and boil & bite. Concerning the production: The evaluation differed from other questionnaire items. No significant difference was found among all four kinds of mouthguard, so there was no difference in the fabrication difficulty. Concerning the selection and spread: The evaluation was almost the same as for the feeling. The laminated mouthguard was assessed to be the best mouthguard. CONCLUSIONS The boil & bite mouthguard which is widespread was evaluated the lowest in all items except production. Therefore, it is necessary to encourage players to use an appropriate custom-made type in view of safety, wearing feeling, and dental occlusion.

PURPOSE A mouthguard can protect stomatognathic systems from traumatic damage. However, severe occlusal wear of teeth and loss of teeth have often been found in players clinically. These problems might originate in strong clenching during sports. Although it is thought that a mouthguard may be effective for these types of clenching, the relation between mouthguards and clenching has not been sufficiently examined. In this study, the effect of a mouthguard (Drufosoft 3mm, EVA) on tooth distortion caused by clenching was measured and examined at three different clenching strengths. METHODS As a test tooth, a lower first molar was selected. A strain gauge applied to the outer surface of the buccal cusp was used to measure the distortion. A muscle balance monitor (GC) was used to regulate clenching strengths (10, 50, and 100%). The maximum-effort clenching without a mouthguard was assumed to be the 100% clenching strength. Measurements were conducted with or without mouthguard. A maximum value during clenching was assumed to be date of distortion by using analytical software AcquKnowledge (BIOPAC System Inc.). Statistical analysis software SPSS (SPSS Japan Inc.) was used for the Mann-Whitney test. RESULTS 1. The tooth distortion by clenching, regardless of the presence of the mouthguard, increased as clenching power strengthened, from 10, 50 to 100%. 2. The tooth distortion, regardless of strength of clenching, was decreased by wearing the mouthguard in all subjects. At 50 and 100% clenching, it was decreased significantly by the mouthguard in all subjects. CONCLUSIONS Mouthguards decreaseed the tooth distortion caused by clenching. Therefore, a mouthguard may prevent not only traumatic injuries in contact sports but also damage to teeth and periodontal tissues and so on, which occur due to frequent strong clenching in many sports.

Mouthguards have been tested for impact energy absorption using drop-ball and/or pendulum devices. While all reports show efficiency of the mouthguard, the impact absorption abilities reported differ considerably. This difference has been attributed to differences of mouthguard material, design, and the impact force used. However, it is also possibly because of the difference in the sensors used in the experiments. The purpose of this study was to test three types of sensors and to assess which type was most appropriate for measurement of the impact absorption ability of mouthguards. A pendulum-type testing equipment and steel ball, wooden bat, baseball, field-hockey ball were used as the impact object. For all sensors or impact objects, the mouthguard decreased the impact forces. However, the absorption ability of the mouthguard varied according to the sensor or impact object. The absorbency values became smaller with the strain gauge, the accelerometer, and the load cell, respectively. With the steel ball as the impact object, 80.3% of impact absorption was measured with the strain gauge and the accelerometer but, only 62.1% with the load cell sensor. With the wooden bat, impact absorption was 76.3% with the strain gauge and 38.8% for the load cell. For the baseball ball, the absorption measurement decreased from 46.3% with the strain gauge to 4.36 with the load cell and for the field-hockey ball, the decrease in measurement values were similar (23.6% with the strain gauge and 2.43% with the load cell). It is clear that the sensor plays an important role in the measurement values reported for absorbency of mouthguard materials and a standard sensor should be used for all experiments.